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Addressing the HIV Prevention Needs of Black Men & Women

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Camille Abrahams Emeagwali
Camille Abrahams Emeagwali

This document outlines plans to implement an HIV prevention intervention called Safety Counts for Black/African American men who use drugs and have sex with women. It discusses conducting assessments of the target population to understand their risks and needs. The intervention will be adapted from its original form to address relationship issues specific to the community. Process and outcome objectives are established, along with an evaluation plan, to measure the success of recruiting participants, changing their behaviors and linking them to other services. Partnerships with local organizations will allow for joint implementation of Safety Counts and a complementary women's intervention.

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Expanding the Reach of HRC: Addressing the HIV Prevention Needs of Black/African American Men & Women Camille A. Abrahams, MS Harm Reduction Coalition September 2008 CDC/ASPH Institute for HIV Prevention Leadership 1
Summary of Presentation Overview of Strategic Planning Process Mission, Vision and Goals Strategic Issue: Activities, Evaluation, Resources Needed Overview of Project Initiative Community Assessment Process Intervention Activities Evaluation Activities Budget 2
Harm Reduction Coalition Mission: The Harm Reduction Coalition (HRC) is a national advocacy and capacity-building organization that promotes the health and human rights of people who use drugs and confronts the adverse effects of drug use, by advocating for effective policy responses to drug-related harms, by serving as an incubator for new ideas, and by promoting best practices for the harm reduction movement. HRC advances policies and programs that help people address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration. Vision We recognize that the structures of social inequality impact the lives and options of affected communities differently, and work to uphold every individual's right to health and well-being, as well as in their competence to protect themselves, their loved ones, and their communities. 3
HRCs National Goals Lead national advocacy campaigns on the following issues: Lifting the federal ban on syringe exchange funding, increased Increase government funding for community-based hepatitis C programs Developing a comprehensive plan on the federal level to reduce overdose mortality Improve federal policy/prescribing guidelines to increase access to Buprenophrine HRC will accomplish these goals as a national capacity builder for programs addressing the harm reduction, prevention, and treatment needs of people who use drugs. HRC will also develop and promote minimum standards for harm reduction service provision . 4
African American Capacity Building Initiative The African American Capacity Building Capacity Building Initiative (AACBI) is a CDC-funded program that was founded in 2004 to assist community based organizations (CBOs), health departments (HDs) and other community stakeholders serving the African American community in the CDCs North Region. Goals: To strengthen the capacity of CBOs & HDs to develop and implement effective HIV prevention interventions. To decrease the number of people at risk of acquiring or transmitting HIV infection. 5
Strategic Planning Group Harm Reduction Coalition Jagadisa-devasri Dacus, MSW, Senior Director of Training & Capacity Building Programs Dorcey Jones, MPH, Capacity Building Assistance Specialist Hunter College School of Social Work Darrell Wheeler, PhD. Associate Dean for Research/Associate Professor and AACBI Behavioral and Social Science Consultant Bernadette Hadden, PhD, Assistant Professor and AACBI Evaluation Consultant Brick Rebuilding Allen Frimpong, Founder and Program Coordinator 6
Strategic Issue Stabilizing the program staff by addressing recent staff turnover and challenges filling the positions. Rationale for Issue: AACBI recently experienced a long-term period of instability as a result of a vital program position being vacant for seven months. The Program Director had to juggle both administrative and programmatic work, which was overwhelming both personally and professionally. The Program Director views that period as a lesson learned, and wants to be prepared when staff turnover occurs. 7
Goal and Objectives The goal is to develop and maintain program sustainability for the AACBI program in the event of staff turnover. Objective 1 By April 30, 2009, AACBI/HRC will expand its cadre of trainers/technical assistance providers by recruiting, hiring and training new consultants. Objective 2 By May 30, 2009, AACBI/HRC will develop a staff recruitment and retention plan that will address, among other things, monetary and non-monetary incentives. 8
Objective #1: Recruit, Hire & Train New Consultants OCT NOV DEC JAN FEB 1. Develop job descriptions 2. Post job description 3. Develop selection criteria 4. Identify candidates 5. Invite candidates for interview 6. Interview candidates 7. Observe candidates train 9
Objective #1: Recruit, Hire & Train New Consultants NOV DEC JAN FEB MAR APR 8. Plan orientation 9. Develop orientation manual 10. Host consultant orientation 11. Hire qualified candidates 12. Train new consultants HR 13. Train new consultants CD 10
Objective #2: Develop a Staff Recruitment and Retention Plan OCT NOV DEC JAN 1. Determine staffing needs 2. Evaluate cause of staff turnover 3. Sr. Management Mtg 4. Learn best practices from partners 5. Link R&R plan w/strategic plan 6. Develop R&R plan (short/long term) 7. Develop selection criteria 11
Objective #2: Develop a Staff Recruitment and Retention Plan DEC JAN FEB MAR APR MAY 8. Train/coach managers - perf/change mgmt 9. Draft R&R manual 10. Seek feedback 11. Finalize R&R manual 12. Develop QA plan 13. Plan to review R&R plan annually 12
Evaluation Goal How Will You Measure Achievement? To develop and maintain program Tracking and examining: sustainability for the AACBI program in the staffs length of tenure the event of staff turnover job satisfaction the quality of staff job performance This data will be collected through: Observation Staff supervision Program evaluation (i.e. training evaluation) This data will be reviewed every trimester. 13
Evaluation Objectives How Will Your Measure Achievement? 1. By April 30, 2009, AACBI/HRC will After each recruitment cycle, monitor and expand its cadre of trainers/technical analyze the number of trainers/TA assistance providers by recruiting, providers: hiring and training new consultants. Recruited Added to the consultant pool and compare to the baseline number (pre- recruitment) Completed trainings 2. By May 30, 2009, AACBI/HRC will Monitoring and analyzing the following: develop a staff recruitment and Length of time it takes to recruit new staff retention plan that will address, among Length of staff tenure other things, monetary and non- Staff job satisfaction monetary incentives. Staff job performance14
Safety Counts A Behavioral HIV Intervention For Black Men Who Use Drugs and Have Sex With Women 15
Priority Population Black/African American adult women (ages 20-49) of unknown or HIV-negative status, engaged in heterosexual contact with men who use drugs and live in New York City. Why this population? In NYS, over 42% of African Americans dont know how they were infected. In NYC, 54% of black women acquired HIV from heterosexual contact. Another 27% do not know how they were exposed to HIV. Therefore, the focus of our prevention efforts needs to be on the sexual partners of these women. 16
HRCs Capacity To Work With Priority Population Harm Reduction Coalition is not a direct service agency. Therefore, our capacity to work with this priority population is limited. However, the Board of Directors is open to supporting a program for black women who are partners of drug users (our target population). HRC is a culturally competent organization with experience working with the African American community. Furthermore, HRC has extensive knowledge about drug use and the adverse effects of drug use (e.g. overdose, viral hepatitis, HIV/AIDS, etc.) 17
Assessment & The Theory Behind It Individual Assessment: Web-based Survey questionnaire Target pop - Black/African American women (ages 20-49) of unknown or HIV negative status, engaged in heterosexual contact with men who use drugs Community Assessment: Focus Groups Target Pop - Key Informants and Community Leaders individuals who understand the influence and connection between poverty, incarceration and sexual networks within Black/African American communities that lead to HIV infection among heterosexual women Behavioral Theory :The Theory of Gender and Power The theory argues that self-protection by women is often swayed by economic factors, abusive partnerships, and the socialization of women to be sexually passive or ignorant. The theory incorporates the structure of gender relations, societal definitions of masculinity and femininity, and economic power. 18
Key Findings From Individual Assessment The top two reasons why women did not use condoms all the time with their drug using main partners were: Their partner doesnt like to use condoms They are in a monogamous relationship The main reason why women did not use condoms all the time with their drug using casual partners was a history or potential for partner violence. Although the majority of women surveyed think they are at risk for HIV, that does not always lead to using a condom each and every time with their partner. 19
Key Findings From Community Assessment HIV prevention education does not effectively incorporated drug education, especially understanding how a partners use of drugs can place them at risk for HIV Black/African American women need to find their voice in the fight against HIV. Lack of self- empowerment to protect and defend their needs with their sexual partners Relationship dynamics between men and women need to be functional, balanced and healthy. Economic disparities, unemployment/underemployment for either partner, especially the man, can cause distress in the relationship leading to high-risk behaviors There are stigmas that are specific to the black community (e.g. faith-based homophobia). 20
Safety Counts Safety Counts is an HIV prevention intervention for out-of-treatment active injection and non-injection drug users aimed at reducing both high-risk drug use and sexual behaviors. It is a behaviorally focused, seven-session intervention, which includes both structured and unstructured psycho- educational activities in group and individual settings. The goal of the intervention is to reduce the HIV acquisition and/or transmission incidence for adult men who use drugs and have sex with African American women. Harm Reduction Coalition is in the pre-implementation stage with Safety Counts. In partnership with a direct service provider, Safety Counts can be implemented with fidelity, because two HRC staff members are Safety Counts master trainers and have extensive knowledge of the intervention. 21
Adaptation of Intervention Safety Counts would have to be adapted to serve African American male clients who use drugs and their primary goal behavior is to use a condom. Since the ultimate goal is to effect the risk of African American women who are having sex with men who use drugs, it is important and necessary to link Safety Counts to another intervention for women, SISTA, for their female partners. Both sexual partners will be receiving the same risk reduction messages simultaneously. Safety Counts social events will be open to female sex partner who are also SISTA participants. In addition, another group session will be added to Safety Counts to include information on healthy relationships between black men and black women. 22
Intervention Implementation Stakeholders Stakeholder Name Resources and/or Rationale for Inclusion Adam Viera Serves as program staff, therefore he would be CBA Specialist implementing the intervention. Harm Reduction Coalition Dorcey Jones Serves as program staff, therefore she would be CBA Specialist implementing the intervention. Harm Reduction Coalition Darrell Wheeler, PhD Supports the program with expertise around Behavioral & Social Science Consultant behavioral theory, interventions and the target Hunter College School of Social Work population Bernadette Hadden, PhD Expertise in formative, program and outcome Evaluation Consultant evaluation Hunter College School of Social Work 23
Process Outcome or Behavioral or Goal Objectives Immediate Intermediate Statement Objectives Objective Process Monitoring Outcome Monitoring and Impact and Evaluation Evaluation Evaluation 24
Behavioral or Intermediate Outcome Objective By the completion of the intervention (4 months), each client will have the knowledge and skill to reduce the transmission risks associated with unprotected vaginal and/or anal sexual intercourse. 25
Evaluation of Behavioral Objective Objective Indicator Source of Evidence By the completion of Increase in awareness # of participants that the intervention, 100% of the link between increased their of participants will internalized awareness of the link increase their homophobia and HIV between internalized awareness of the link risk behavior among homophobia and HIV between internalized participants who risk behavior homophobia and HIV completed the risk behavior leading intervention to rising HIV rates among African American women. 26
Outcome or Immediate Outcome Objectives By the completion of the intervention, 75% participants will bring their AA female sex partners to at least one social event, where they will discuss the risk of HIV infection due to drug/alcohol use. By the completion of the intervention, 75% of the Safety Counts participants will receive at least one referral to a job training program . By the completion of the intervention, 100% of participants will increase their awareness of the link between internalized homophobia and HIV. By the completion of the intervention, 75% of Safety Counts participants will state an intention to use condoms with their female sex partners. 27
Evaluation of Outcome Objectives BY THE COMPLETION OF INDICATORS SOURCE(S) OF THE EVIDENCE INTERVENTION: Number of A/A Bring AA female sex partners attending Sign-in sheet female sex Head count at partners to at social event Social Event least one social Program event Number of Social Events Monitoring Form Receive at least Number of job one referral to a training programs in job training List of referrals, referral network program MOAs with job Number of training programs participants referred in referral network to job training , Client Records 28 programs
Evaluation of Outcome Objectives BY THE COMPLETION OF INDICATORS SOURCE(S) OF THE EVIDENCE Increase in awareness of INTERVENTION: the link between awareness of the link internalized between internalized homophobia & HIV Pre and Post homophobia and HIV risk behavior Risk Reduction among participants Interview who completed the intervention state an intention # of participants who Program Monitoring to use condoms completed the intervention Form with their female Client Record sex partners # of participants who Risk Reduction completed the intervention Interview who stated an intention to use condoms with female 29 sex partners
Process Objectives 1. By November 2008, a formal collaborative agreement -- for the purposes of running Safety Counts in conjunction with their SISTA program, recruiting clients, utilizing office space and sharing staff -- with Diaspora Community Services, a direct service provider, will be established via a Memorandum of Agreement (MOA). 2. By January 2009, the Safety Counts staff at HRC and Diaspora (also referred to as The Safety Counts Team) will be hired. 3. By February 2009, a client recruitment and retention plan will be developed by the Safety Counts Team. 4. By February 2009, all Safety Count Team members will have completed a CDC-sanctioned Safety Counts training. 30
Process Objectives 5. By February 2009, all Safety Count Team members will have received an Overview of SISTA by a CDC-funded CBA provider. 6. By March 2009, the Safety Counts Team will pilot-test a new curriculum for a third group session to address the issue of healthy relationships between black men and black women 7. By March 2009, the first cycle of Safety Counts for African American/Black male drug users whose primary goal is to use condoms with their African American female sex partners will begin 8. By April 2009, at least one Social Event will be open to SISTA participants who are receiving the same risk reduction messages simultaneously 9. By September 2009, the Safety Counts Team will evaluate the first completed cycle of the intervention. 31
Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE (due date) # of roles and responsibilities for the implementation of the Formal intervention detailed in the Agreement MOA MOA through MOA # of signatures from Executive (by Nov. 08) Directors of partner organizations Number of Proposed Grant Proposal Hire Safety Staff Hiring Letter, Counts Team Employee Records (by Jan. 09) Number of Staff Actually Hired 32
Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of clients identified to be Recruitment recruited and Grant & Retention retained Application Plan (by Feb Client 09) Records SC Team # of people completing completes the Safety Counts training Certificates of CDC SC completion Increase in knowledge of Training (by Sign-in sheets Safety Counts Feb 09) intervention procedures and policies 33
Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of people completing the SISTA SC Team Overview training Certificates of completes attendance Increase in knowledge CDC SISTA Sign-in sheets of SISTA intervention Training (by procedures and Feb 09) policies #of priority population Pilot 3rd participating in pilot test Sign-in sheet Group Session re: healthy Increase in participants Pre-Post Test black knowledge about healthy One-on-one relationships relationships interviews with (by Mar 09) participants 34
Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of participants who Begin the 1st attended Group Sign-in sheets cycle of Session 1 Client Safety Counts Records Number of Group Program (by Mar 09) Sessions that occur Monitoring Form Number of SISTA At least one SC participants invited to List of invited Social Event the Social Events guests open to SISTA participants (by Number of Social Invitations Apr 09) Events Program Monitoring Form 35
Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Evaluate the Number of core Program first elements implemented Monitoring Form completed Pre and post Risk Increase in knowledge cycle of SC Reduction Interview and skills of the (by Sep 09) Client Participation participants Record 36
Resources Needed Personnel Other Direct Costs Program Manager Travel Counselor/Facilitator I Consultants Outreach Office Supplies Worker/Facilitator II Educational Materials Program Assistant Stipends Printing Telephone/Internet Postage/Delivery Equipment Furniture 37
Year 1 Budget Strategic Plan Intervention Plan Total Personnel $52,800 $96,600 $149,400 Consultants $5,000 $10,000 $15,000 Stipends $2,000 $7,000 $9,000 Equipment $0 $12,000 $12,000 Travel $0 $5,000 $5,000 Supplies $1,000 $5,000 $6,000 Other Direct Costs $7,500 $17,500 $25,000 Indirect Costs 10,245 $22,965 $33,210 Total $78,545 $176,065 38 $254,610
Closing Remarks Safety Counts, in partnership with SISTA, is an effective intervention that will reduce the transmission of HIV among Black/African American adult men who use drugs and have unprotected sex with Black/African American women. This unique partnership between two behavioral interventions will be cost-effective while meeting its goal to increase the knowledge and skills of clients and their partners. AACBI/HRC is a culturally competent program that has an excellent performance record as well as strong relationships in the community to make this initiative a success! 39

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Addressing the HIV Prevention Needs of Black Men & Women

  • 1. Expanding the Reach of HRC: Addressing the HIV Prevention Needs of Black/African American Men & Women Camille A. Abrahams, MS Harm Reduction Coalition September 2008 CDC/ASPH Institute for HIV Prevention Leadership 1
  • 2. Summary of Presentation Overview of Strategic Planning Process Mission, Vision and Goals Strategic Issue: Activities, Evaluation, Resources Needed Overview of Project Initiative Community Assessment Process Intervention Activities Evaluation Activities Budget 2
  • 3. Harm Reduction Coalition Mission: The Harm Reduction Coalition (HRC) is a national advocacy and capacity-building organization that promotes the health and human rights of people who use drugs and confronts the adverse effects of drug use, by advocating for effective policy responses to drug-related harms, by serving as an incubator for new ideas, and by promoting best practices for the harm reduction movement. HRC advances policies and programs that help people address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration. Vision We recognize that the structures of social inequality impact the lives and options of affected communities differently, and work to uphold every individual's right to health and well-being, as well as in their competence to protect themselves, their loved ones, and their communities. 3
  • 4. HRCs National Goals Lead national advocacy campaigns on the following issues: Lifting the federal ban on syringe exchange funding, increased Increase government funding for community-based hepatitis C programs Developing a comprehensive plan on the federal level to reduce overdose mortality Improve federal policy/prescribing guidelines to increase access to Buprenophrine HRC will accomplish these goals as a national capacity builder for programs addressing the harm reduction, prevention, and treatment needs of people who use drugs. HRC will also develop and promote minimum standards for harm reduction service provision . 4
  • 5. African American Capacity Building Initiative The African American Capacity Building Capacity Building Initiative (AACBI) is a CDC-funded program that was founded in 2004 to assist community based organizations (CBOs), health departments (HDs) and other community stakeholders serving the African American community in the CDCs North Region. Goals: To strengthen the capacity of CBOs & HDs to develop and implement effective HIV prevention interventions. To decrease the number of people at risk of acquiring or transmitting HIV infection. 5
  • 6. Strategic Planning Group Harm Reduction Coalition Jagadisa-devasri Dacus, MSW, Senior Director of Training & Capacity Building Programs Dorcey Jones, MPH, Capacity Building Assistance Specialist Hunter College School of Social Work Darrell Wheeler, PhD. Associate Dean for Research/Associate Professor and AACBI Behavioral and Social Science Consultant Bernadette Hadden, PhD, Assistant Professor and AACBI Evaluation Consultant Brick Rebuilding Allen Frimpong, Founder and Program Coordinator 6
  • 7. Strategic Issue Stabilizing the program staff by addressing recent staff turnover and challenges filling the positions. Rationale for Issue: AACBI recently experienced a long-term period of instability as a result of a vital program position being vacant for seven months. The Program Director had to juggle both administrative and programmatic work, which was overwhelming both personally and professionally. The Program Director views that period as a lesson learned, and wants to be prepared when staff turnover occurs. 7
  • 8. Goal and Objectives The goal is to develop and maintain program sustainability for the AACBI program in the event of staff turnover. Objective 1 By April 30, 2009, AACBI/HRC will expand its cadre of trainers/technical assistance providers by recruiting, hiring and training new consultants. Objective 2 By May 30, 2009, AACBI/HRC will develop a staff recruitment and retention plan that will address, among other things, monetary and non-monetary incentives. 8
  • 9. Objective #1: Recruit, Hire & Train New Consultants OCT NOV DEC JAN FEB 1. Develop job descriptions 2. Post job description 3. Develop selection criteria 4. Identify candidates 5. Invite candidates for interview 6. Interview candidates 7. Observe candidates train 9
  • 10. Objective #1: Recruit, Hire & Train New Consultants NOV DEC JAN FEB MAR APR 8. Plan orientation 9. Develop orientation manual 10. Host consultant orientation 11. Hire qualified candidates 12. Train new consultants HR 13. Train new consultants CD 10
  • 11. Objective #2: Develop a Staff Recruitment and Retention Plan OCT NOV DEC JAN 1. Determine staffing needs 2. Evaluate cause of staff turnover 3. Sr. Management Mtg 4. Learn best practices from partners 5. Link R&R plan w/strategic plan 6. Develop R&R plan (short/long term) 7. Develop selection criteria 11
  • 12. Objective #2: Develop a Staff Recruitment and Retention Plan DEC JAN FEB MAR APR MAY 8. Train/coach managers - perf/change mgmt 9. Draft R&R manual 10. Seek feedback 11. Finalize R&R manual 12. Develop QA plan 13. Plan to review R&R plan annually 12
  • 13. Evaluation Goal How Will You Measure Achievement? To develop and maintain program Tracking and examining: sustainability for the AACBI program in the staffs length of tenure the event of staff turnover job satisfaction the quality of staff job performance This data will be collected through: Observation Staff supervision Program evaluation (i.e. training evaluation) This data will be reviewed every trimester. 13
  • 14. Evaluation Objectives How Will Your Measure Achievement? 1. By April 30, 2009, AACBI/HRC will After each recruitment cycle, monitor and expand its cadre of trainers/technical analyze the number of trainers/TA assistance providers by recruiting, providers: hiring and training new consultants. Recruited Added to the consultant pool and compare to the baseline number (pre- recruitment) Completed trainings 2. By May 30, 2009, AACBI/HRC will Monitoring and analyzing the following: develop a staff recruitment and Length of time it takes to recruit new staff retention plan that will address, among Length of staff tenure other things, monetary and non- Staff job satisfaction monetary incentives. Staff job performance14
  • 15. Safety Counts A Behavioral HIV Intervention For Black Men Who Use Drugs and Have Sex With Women 15
  • 16. Priority Population Black/African American adult women (ages 20-49) of unknown or HIV-negative status, engaged in heterosexual contact with men who use drugs and live in New York City. Why this population? In NYS, over 42% of African Americans dont know how they were infected. In NYC, 54% of black women acquired HIV from heterosexual contact. Another 27% do not know how they were exposed to HIV. Therefore, the focus of our prevention efforts needs to be on the sexual partners of these women. 16
  • 17. HRCs Capacity To Work With Priority Population Harm Reduction Coalition is not a direct service agency. Therefore, our capacity to work with this priority population is limited. However, the Board of Directors is open to supporting a program for black women who are partners of drug users (our target population). HRC is a culturally competent organization with experience working with the African American community. Furthermore, HRC has extensive knowledge about drug use and the adverse effects of drug use (e.g. overdose, viral hepatitis, HIV/AIDS, etc.) 17
  • 18. Assessment & The Theory Behind It Individual Assessment: Web-based Survey questionnaire Target pop - Black/African American women (ages 20-49) of unknown or HIV negative status, engaged in heterosexual contact with men who use drugs Community Assessment: Focus Groups Target Pop - Key Informants and Community Leaders individuals who understand the influence and connection between poverty, incarceration and sexual networks within Black/African American communities that lead to HIV infection among heterosexual women Behavioral Theory :The Theory of Gender and Power The theory argues that self-protection by women is often swayed by economic factors, abusive partnerships, and the socialization of women to be sexually passive or ignorant. The theory incorporates the structure of gender relations, societal definitions of masculinity and femininity, and economic power. 18
  • 19. Key Findings From Individual Assessment The top two reasons why women did not use condoms all the time with their drug using main partners were: Their partner doesnt like to use condoms They are in a monogamous relationship The main reason why women did not use condoms all the time with their drug using casual partners was a history or potential for partner violence. Although the majority of women surveyed think they are at risk for HIV, that does not always lead to using a condom each and every time with their partner. 19
  • 20. Key Findings From Community Assessment HIV prevention education does not effectively incorporated drug education, especially understanding how a partners use of drugs can place them at risk for HIV Black/African American women need to find their voice in the fight against HIV. Lack of self- empowerment to protect and defend their needs with their sexual partners Relationship dynamics between men and women need to be functional, balanced and healthy. Economic disparities, unemployment/underemployment for either partner, especially the man, can cause distress in the relationship leading to high-risk behaviors There are stigmas that are specific to the black community (e.g. faith-based homophobia). 20
  • 21. Safety Counts Safety Counts is an HIV prevention intervention for out-of-treatment active injection and non-injection drug users aimed at reducing both high-risk drug use and sexual behaviors. It is a behaviorally focused, seven-session intervention, which includes both structured and unstructured psycho- educational activities in group and individual settings. The goal of the intervention is to reduce the HIV acquisition and/or transmission incidence for adult men who use drugs and have sex with African American women. Harm Reduction Coalition is in the pre-implementation stage with Safety Counts. In partnership with a direct service provider, Safety Counts can be implemented with fidelity, because two HRC staff members are Safety Counts master trainers and have extensive knowledge of the intervention. 21
  • 22. Adaptation of Intervention Safety Counts would have to be adapted to serve African American male clients who use drugs and their primary goal behavior is to use a condom. Since the ultimate goal is to effect the risk of African American women who are having sex with men who use drugs, it is important and necessary to link Safety Counts to another intervention for women, SISTA, for their female partners. Both sexual partners will be receiving the same risk reduction messages simultaneously. Safety Counts social events will be open to female sex partner who are also SISTA participants. In addition, another group session will be added to Safety Counts to include information on healthy relationships between black men and black women. 22
  • 23. Intervention Implementation Stakeholders Stakeholder Name Resources and/or Rationale for Inclusion Adam Viera Serves as program staff, therefore he would be CBA Specialist implementing the intervention. Harm Reduction Coalition Dorcey Jones Serves as program staff, therefore she would be CBA Specialist implementing the intervention. Harm Reduction Coalition Darrell Wheeler, PhD Supports the program with expertise around Behavioral & Social Science Consultant behavioral theory, interventions and the target Hunter College School of Social Work population Bernadette Hadden, PhD Expertise in formative, program and outcome Evaluation Consultant evaluation Hunter College School of Social Work 23
  • 24. Process Outcome or Behavioral or Goal Objectives Immediate Intermediate Statement Objectives Objective Process Monitoring Outcome Monitoring and Impact and Evaluation Evaluation Evaluation 24
  • 25. Behavioral or Intermediate Outcome Objective By the completion of the intervention (4 months), each client will have the knowledge and skill to reduce the transmission risks associated with unprotected vaginal and/or anal sexual intercourse. 25
  • 26. Evaluation of Behavioral Objective Objective Indicator Source of Evidence By the completion of Increase in awareness # of participants that the intervention, 100% of the link between increased their of participants will internalized awareness of the link increase their homophobia and HIV between internalized awareness of the link risk behavior among homophobia and HIV between internalized participants who risk behavior homophobia and HIV completed the risk behavior leading intervention to rising HIV rates among African American women. 26
  • 27. Outcome or Immediate Outcome Objectives By the completion of the intervention, 75% participants will bring their AA female sex partners to at least one social event, where they will discuss the risk of HIV infection due to drug/alcohol use. By the completion of the intervention, 75% of the Safety Counts participants will receive at least one referral to a job training program . By the completion of the intervention, 100% of participants will increase their awareness of the link between internalized homophobia and HIV. By the completion of the intervention, 75% of Safety Counts participants will state an intention to use condoms with their female sex partners. 27
  • 28. Evaluation of Outcome Objectives BY THE COMPLETION OF INDICATORS SOURCE(S) OF THE EVIDENCE INTERVENTION: Number of A/A Bring AA female sex partners attending Sign-in sheet female sex Head count at partners to at social event Social Event least one social Program event Number of Social Events Monitoring Form Receive at least Number of job one referral to a training programs in job training List of referrals, referral network program MOAs with job Number of training programs participants referred in referral network to job training , Client Records 28 programs
  • 29. Evaluation of Outcome Objectives BY THE COMPLETION OF INDICATORS SOURCE(S) OF THE EVIDENCE Increase in awareness of INTERVENTION: the link between awareness of the link internalized between internalized homophobia & HIV Pre and Post homophobia and HIV risk behavior Risk Reduction among participants Interview who completed the intervention state an intention # of participants who Program Monitoring to use condoms completed the intervention Form with their female Client Record sex partners # of participants who Risk Reduction completed the intervention Interview who stated an intention to use condoms with female 29 sex partners
  • 30. Process Objectives 1. By November 2008, a formal collaborative agreement -- for the purposes of running Safety Counts in conjunction with their SISTA program, recruiting clients, utilizing office space and sharing staff -- with Diaspora Community Services, a direct service provider, will be established via a Memorandum of Agreement (MOA). 2. By January 2009, the Safety Counts staff at HRC and Diaspora (also referred to as The Safety Counts Team) will be hired. 3. By February 2009, a client recruitment and retention plan will be developed by the Safety Counts Team. 4. By February 2009, all Safety Count Team members will have completed a CDC-sanctioned Safety Counts training. 30
  • 31. Process Objectives 5. By February 2009, all Safety Count Team members will have received an Overview of SISTA by a CDC-funded CBA provider. 6. By March 2009, the Safety Counts Team will pilot-test a new curriculum for a third group session to address the issue of healthy relationships between black men and black women 7. By March 2009, the first cycle of Safety Counts for African American/Black male drug users whose primary goal is to use condoms with their African American female sex partners will begin 8. By April 2009, at least one Social Event will be open to SISTA participants who are receiving the same risk reduction messages simultaneously 9. By September 2009, the Safety Counts Team will evaluate the first completed cycle of the intervention. 31
  • 32. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE (due date) # of roles and responsibilities for the implementation of the Formal intervention detailed in the Agreement MOA MOA through MOA # of signatures from Executive (by Nov. 08) Directors of partner organizations Number of Proposed Grant Proposal Hire Safety Staff Hiring Letter, Counts Team Employee Records (by Jan. 09) Number of Staff Actually Hired 32
  • 33. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of clients identified to be Recruitment recruited and Grant & Retention retained Application Plan (by Feb Client 09) Records SC Team # of people completing completes the Safety Counts training Certificates of CDC SC completion Increase in knowledge of Training (by Sign-in sheets Safety Counts Feb 09) intervention procedures and policies 33
  • 34. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of people completing the SISTA SC Team Overview training Certificates of completes attendance Increase in knowledge CDC SISTA Sign-in sheets of SISTA intervention Training (by procedures and Feb 09) policies #of priority population Pilot 3rd participating in pilot test Sign-in sheet Group Session re: healthy Increase in participants Pre-Post Test black knowledge about healthy One-on-one relationships relationships interviews with (by Mar 09) participants 34
  • 35. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of participants who Begin the 1st attended Group Sign-in sheets cycle of Session 1 Client Safety Counts Records Number of Group Program (by Mar 09) Sessions that occur Monitoring Form Number of SISTA At least one SC participants invited to List of invited Social Event the Social Events guests open to SISTA participants (by Number of Social Invitations Apr 09) Events Program Monitoring Form 35
  • 36. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Evaluate the Number of core Program first elements implemented Monitoring Form completed Pre and post Risk Increase in knowledge cycle of SC Reduction Interview and skills of the (by Sep 09) Client Participation participants Record 36
  • 37. Resources Needed Personnel Other Direct Costs Program Manager Travel Counselor/Facilitator I Consultants Outreach Office Supplies Worker/Facilitator II Educational Materials Program Assistant Stipends Printing Telephone/Internet Postage/Delivery Equipment Furniture 37
  • 38. Year 1 Budget Strategic Plan Intervention Plan Total Personnel $52,800 $96,600 $149,400 Consultants $5,000 $10,000 $15,000 Stipends $2,000 $7,000 $9,000 Equipment $0 $12,000 $12,000 Travel $0 $5,000 $5,000 Supplies $1,000 $5,000 $6,000 Other Direct Costs $7,500 $17,500 $25,000 Indirect Costs 10,245 $22,965 $33,210 Total $78,545 $176,065 38 $254,610
  • 39. Closing Remarks Safety Counts, in partnership with SISTA, is an effective intervention that will reduce the transmission of HIV among Black/African American adult men who use drugs and have unprotected sex with Black/African American women. This unique partnership between two behavioral interventions will be cost-effective while meeting its goal to increase the knowledge and skills of clients and their partners. AACBI/HRC is a culturally competent program that has an excellent performance record as well as strong relationships in the community to make this initiative a success! 39

Editor's Notes

  • #6: In providing capacity building assistance (CBA) services, AACBI uses several CBA best practices, including: Cultural Competence Intergration Needs-Driven Action Plans Comprehensive Consumer Involvement Integration of CDC-Endorsed Best Practices Continuous Program Improvement Our goals are aligned with the CDC, which directly funds our program
  • #20: Therefore, in order to address the prevention needs of black/African American heterosexual women with drug using sex partners, it is necessary to address four key issues: The influence of main sex partners on the use of barrier methods (i.e. desire to use condoms) Relationship status with main partner (i.e. monogamy, marriage) History or threat of intimate partner violence The influence of a womans drug and alcohol use on their sexual behavior.
  • #21: Based on the responses of focus group participants, the best way to meet the HIV prevention needs of this priority population are: Black/African American women speaking up and out about their needs to decision makers regarding policy, funding and media attention Becoming an integral part in program design and delivery at community based organizations Utilizing an integrated approach to HIV prevention services to include all relevant programs/services, such as domestic violence, shelters, food banks, religious/spiritual organizations, etc. Peers reaching out to women and their partners in nontraditional entities (i.e. beauty salons, barber shops, etc.) Mental health services for women, men and couples Teaching women to self-stimulate when their partners are not around or eroticize condoms in relationships with partners.
  • #39: Other Direct Costs (e.g. educational materials, printing, telephone, postage, etc.